Fall 2009 Course Description

Topics in Global Policy Studies

Section Title: Politics of Health Reform
Instructor(s): Benjamin Sasse
Course: P A 188G - Topics in Global Policy Studies
Unique Number: 63035
Day & Time: Mondays, 9:00 AM - 12:00 PM
Room: SRH 3.312
Waitlist Information:For LBJ Students: UT Waitlist Information
Notes: Class meets 8/31 - 10/5/09

This course fulfills requirements for the following specialization(s):

Description: Even amid two wars and a generational economic meltdown, healthcare still polls among the top concerns of average citizens. Americans are right to be anxious about our health sector. Forty-seven million of us are uninsured, and nearly eighty million will be at some point in the next year. Quality of care is difficult to measure in most instances, and is regularly not the best in the world. Costs are out of control – for families and for firms.

Less well understood by voters is the cost problem for the nation. The baby boomer demographic bulge begins hitting retirement age in 2011. Healthcare spending has been growing at double the rest of the economy for forty years, and at seventeen percent of GDP, healthcare is already the largest sector of the economy. We are beginning a decline from 3.8 workers per retiree today to only 2.4 workers twenty years from now. The Medicare Part A Trust Fund (which pays hospital bills) is projected to be bankrupt in seven years, and the government’s unfunded obligations for the program now add up to five times more than the Social Security obligations and three times more than the entire national debt.

Reform is long overdue – and so, not wanting to disappoint, Washington is aglow with grand claims that fundamental health reform will come by the end of this year.

But will it really? Similar claims have been made every few years for decades – and yet fundamental reform to our outdated employer-based, factory-era pooling arrangements and to our perverse payments systems never actually comes.

Why not? If the problems are so urgent, why is action so often delayed by lobbying and political infighting? Because genuine reform cannot be achieved by politicians making one-off tweaks and adjustments. Real reform would mean very real losers – large tax increases, huge benefit cuts, and/or radically reduced hospital and doctor reimbursement rates. Which senators are on the Sunday morning talk shows proposing that? Which leaders from the House of Representatives are out at town halls admitting this to their constituents? Politicians don’t do that. They do not typically volunteer to tell voters that a crisis is much worse than they think, and that the solution is for citizens to suffer more – for doctors to be paid less, or for taxes to go up, or for the retirement age to increase since life expectancy has, or for fewer of grandma’s procedures to be covered by Medicare.

This five-week course will provide an overview of the policy, politics, and economics of the health sector and of various health reform proposals in particular. Featuring some senior administration officials and other key actors in the health reform drama, this class will seek to understand the complicated motives of hospitals, doctors, insurers, the pharmaceutical industry, device manufacturers, and patient advocates. For healthcare is not only the largest sector of the U.S. economy; it is also the most lobbied space in Washington.

Return to Fall 2009 Course Schedule